title: Medication and suicide risk in schizophrenia: a nested case-control study.
abstract: BACKGROUND
  Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of pharmacotherapy in relation to suicide risk is limited.
  
  
  OBJECTIVE
  To explore suicide risk in schizophrenia in relation to medication with antipsychotics, antidepressants, and lithium.
  
  
  METHODS
  Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individually matched controls were identified from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Adjusted odds ratios [OR] of the association between medication and suicide were calculated by conditional logistic regression.
  
  
  RESULTS
  Lower suicide risk was found in patients who had been prescribed a second generation antipsychotic (clozapine, olanzapine, risperidone, or ziprasidone; 12 cases and 20 controls): OR 0.29 (95% confidence interval [CI], 0.09-0.97). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.23 (95% CI 0.06-0.89). No significant association was observed between suicide and prescription of any antipsychotic, depot injection antipsychotics, antidepressants, SSRI, or lithium.
  
  
  CONCLUSIONS
  Lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these drugs, to differences in adherence, or to differences in other patient characteristics associated with lower suicide risk.
authors.affiliation: Centre for Pharmacoepidemiology (CPE), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: johan.reutfors@ki.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Reutfors
authors.forename: Shahram
authors.initials: S
authors.lastname: Bahmanyar
authors.forename: Erik G
authors.initials: EG
authors.lastname: Jönsson
authors.forename: Lena
authors.initials: L
authors.lastname: Brandt
authors.forename: Robert
authors.initials: R
authors.lastname: Bodén
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Urban
authors.initials: U
authors.lastname: Osby
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018021:Lithium Chloride / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012306:Risk; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016728:Self-Injurious Behavior / Q000139:chemically induced*; D012737:Sex Factors; D013405:Suicide / Q000523:psychology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018021:Lithium Chloride
keywords: Antidepressant drugs; Antipsychotic drugs; Case–control study; Lithium; Schizophrenia; Suicide